wpls jan 2016 mi presentation...initial training a workshop is only the beginning of learning...

Motivational Interviewing:Third Edition: A State-of-the-Science

Introduction

Presented by:

William B. Webb, Ph.D., L.I.C.S.W., M.A.C.

Director, OASIS Behavioral Health Services

689 Central Ave.

P.O. Box 219

Barboursville, WV 25504-0219

Phone: (304) 733-3331

Email: [email protected]

Website: www.PsychOasis.com

1

MOTIVATIONAL INTERVIEWING:

A Comprehensive Introduction to Concepts, Principles and Strategies

TRAINING AGENDA

(Tentative)

Times

9:00 - 10:15 Session - 1

10:15 – 10:30 BREAK

10:30 – 11:45 Session - 2

12:15 – 1:00 LUNCH

1:00 – 2:15 Session - 3

2:15 – 2:30 BREAK

2:30 – 4:00 Session - 4

2

None

Principles of Motivational Interviewing

Pre-Post Quiz

Use this scale to rate your understanding of motivational interviewing methodology

0 1 2 3 4 5 6 7 8 9 10

Moderate Very High

How would you rate your understanding of these basic principles of motivational interviewing? Pre Post

Assessing the stages of change

Methods for setting an agenda

Establishing the “spirit” for motivating change

Expressing empathy

Developing discrepancy

Rolling with resistance

Supporting self-efficacy

Avoiding triggering resistance

Techniques for resolving ambivalence

Communication traps to avoid

Techniques to reduce resistance

Identifying types of “change talk”

Evoking “change talk”

Assessing commitment to change

Responding to “change talk”

Use of effective focusing techniques

Practical application of the decisional balance technique

Ways of strengthening commitment to change

Negotiating a written change plan

TOTAL SCORES

3

Initial TrainingA workshop is only the beginning of learning MI.

Learning Goals:

1. To understand the underlying spirit and approach of MI.

2. To recognize the reflective listening responses and differentiate them from

other counseling responses.

3. To be able to provide at least 50% reflective listening responses during a

conversation.

4. To recognize change talk and be able to differentiate commitment

language from other types of change talk.

5. To list and demonstrate several different strategies for eliciting client

change talk.

A workshop without follow-up is unlikely to make a significant difference in

practice.

Research indicates that personal feedback and performance coaching are

necessary to effectively integrate MI skills. 4

How to Integrate this Training

Recommended Skill-Development Format

Study

Practice

Extend

•Workshops

•Readings

•Tapes

•Videos

•Website

•Review Research

•Training

•Audio/Video critiques

•Coaching

•Feedback

•In-vivo application

•Further training

•Mint

•List serve

•Measure effectiveness5

The Transtheoretical

Model of

Stages of Change

Prochaska, DiClemente,

and Norcross (1994)

6

Stages of Change Model

PrecontemplationIncrease Awareness

ContemplationMotivate & increase

self-efficacy

PreparationNegotiate plan

ActionImplement Plan

F/U

RelapseAssist in coping

MaintenanceReaffirm commitment

Active problem solving

Termination

7

The Spiral of Change

8

As the degree of mismatch increases between yourself and the client in

readiness for change, the likelihood of resistance increases proportionately.

Other

person

Your

Viewpoint

Differing viewpoints on readiness for change.

9

1 10

Not Ready Unsure Very Ready

??

?

People come in within a certain range of motivation.

What you say influences where they end up.

Movement Along the Motivational Continuum

10

The Transtheoretical Model of Change:

A Six-Step Process

Stage 1 - Precontemplation

“What, me have a problem? No way!”

Stage II – Contemplation

“Maybe I need to change something,

but I’m not sure what to do”

Stage III – Preparation

“Yes, there’s a problem and I’m going to change it”

11

Stage IV –Action

“I’m doing something about my problem.”

Stage V – Maintenance

“I’m an old pro now.”

Stage VI – Termination

“I’m not even tempted anymore”

Ancillary Stage VII – Relapse/Recycling

“Whoops! I slipped back into my old habit!”12

The Stages of Change Model

Pro

gre

ss

Rel

apse

Precontemplation

Contemplation

Preparation

Action

Maintenance

13

Processes of Change in Correlation to Stages

of ChangePrecontemplation Contemplation Preparation Action Maintenance

1. Consciousness Raising→→→→→→→→→→

2. Social Liberation→→→→→→→→→→→→→

3. Emotional Arousal→→→→→→→→→

4. Self Re-evaluation→→→→→→→→→

5.

Commitment→→→→→→→→→→→→→→→→

6.

Reward→→→→→→→→→→→→

7. Countering→→→→→→→→→→

8. Environmental Control→→→→→

9. Helping

Relationships→

14

Not Ready Unsure Ready Trying

1…..2….. 3…..4…..5 6…..7…..8 9…..10

Pre-contemplation Contemplation Preparation Action

Readiness Levels

15

Stages of Change – Therapist Tasks

Stage Tasks

Precontemplation Raise doubt – Increase awareness of

risks of current behavior

Contemplation Tip the decisional balance – Evoke

reasons for change; risks of status quo;

strengthen self-efficacy

Preparation Assist in developing a change plan

Action Help client implement the plan; use

problem solving and support self-

efficacy

Maintenance Develop relapse prevention strategies;

resolve associated problems

Relapse Recycle through earlier stages; alter

action plan; avoid demoralization

16

Stages of Change – Patient Tasks

Stage Tasks

Precontemplation

- Not interested

Become aware and concerned

Contemplation

- Considering

Risk/Reward analysis and decision

making

Preparation

- Planning

Creating an action plan

Action

- Initiate change

Implement plan and revise as needed

Maintenance

- Sustain change

Consolidate change into lifestyle

17

Summary: Stages of Change

•About the process of change

•Compatible with different tx. models

•Change occurs all the time

•Many people change without help

•People fluctuate among SOC

•Emphasizes positive reasons for change

•People require more motivation in early stages

•Combined with MI, it helps people decide on their own

plan of action

18

“It is not the strongest of the species that

survives, nor the most intelligent, but the one

most responsive to change.”

- Charles Darwin (1809-1882)

19

Motivational Interviewing:

An Overview

Miller and Rollnick

(2002, 2nd Ed.)

20

Principles of Person-Centered Change

1. Our services exist to benefit others.

2. Change is fundamentally self-change.

3. People are experts on themselves.

4. We don’t make change happen.

5. We don’t have to come up with all the solutions

6. People have their own resources to effect change

7. Change requires a collaboration of experience.

8. Start where the client is: “Seek first to understand.” (Covey)

9. A conversation about change is not a power trip.

10. Motivation is evoked, not installed.

11. It’s not a change-goal until the client adopts it.21

MI and Change

• What is Motivational Interviewing?

• What is it for?

• Why would I want to learn this?

• How would I use it?

“Things do not change; we change.” – Henry David Thoreau

“MI is about arranging conversations so that people talk

themselves into change.” – MI-3, p.4

22

“Motivation is a fire from within.

If someone else tries to light that fire under you,

chances are it will burn very briefly.”

- Stephen R. Covey, (1932-Present)

23

Why Do People Change?

• People change voluntarily only when:

– They become interested in or concerned about the need

for change.

– They become convinced that the change is in their best

interests or will benefit them more than cost them.

– They organize a plan of action that they are committed to

implementing.

– They take the steps necessary to make and sustain the

change.

24

Sources of Motivation:

External Pressure

+

Internal Motivation

Externally motivated subjects had long term outcomes only

when they also had high levels of internal motivation

(Deci, 2000)

25

Self Determination Theory: SDT

Internal motivation is enhanced by:

• Autonomy - Freedom to choose

• Competence - Self efficacy

• Relatedness - Relationships heal

BREHM’S REACTANCE THEORY = whenever a particular behavior is threatened,

the desirability of that behavior increases.

Ex: “You can not use drugs while on probation!”

1. (Brehm 1981)

2. (Miller, Rollnick 2002)

3. (Hubble Duncan and Miller, 1999)26

New Findings on Motivation:

• Motivation predicts action

• Motivation is changeable

• Motivation is behavior specific

• Motivation is interactive

• Internal motivation lasts longer than external

27

Key Concepts about Motivation

“Motivation is the application of energy to act in pursuit

of some perceived (goal).”

- Keller, 2012

“Most people trust themselves more than others. People

learn about their own attitudes by hearing themselves

talk.”

- Bem, 1972

“Change is an inside job, that flows from internal

motivation.”

- Weinstein, 200228

Key Concepts about Motivation“MI is not done ‘to’ or ‘on’ someone, it is done ‘for’

and ‘with’ a person.”

- MI-3, p. 15

“A motivational conversation entails capturing

change-talk and using it in a manner that moves one

in the direction of their goals.”

- Webb, 2015

“You are a midwife, assisting in someone else’s birth.

Facilitate what is happening rather than what you

think ought to happen.”

- Tao Te Ching29

Clinician talks about why

change is important.

Client nods head.

Client thinks about why change is

personally important

Client talks about why change is

personally important

Client makes verbal commitment

to change

Low High

Probability of Behavior Change

30

Motivational Interviewing (MI) is a directive, client-centered approach that

enhances motivation for change, by helping individuals clarify and resolve their

ambivalence about change, and by eliciting change language. It is based on the

principles of collaboration, evocation, and antonymy; while supporting self-

efficacy. This approach has shown good outcome in clinical research with

diverse client populations. It is especially effective in working with resistant

clients. This two (2) day training is designed to provide a broad overview of the

entire system of Motivational Interviewing. However, the specific focus for this

introductory session will be on conveying the spirit and major principles of the

model. Recent research has demonstrated that retention and proficiency of

practical application of MI is significantly enhanced by follow-up sessions,

which include a review of work samples and MI coaching.

Objectives of this training:

• To increase participants’ knowledge of Motivational Interviewing.

• To exhibit the appropriate application of stages of change model to the

Motivational Interviewing approach.

• To demonstrate via lecture, video, and group activities the spirit, principles,

and skill set for the application of Motivational Interviewing.

• To provide in-vivo practice of MI listening skills and methods for

recognizing and dealing with change talk. 31

Motivational Interviewing

• Layperson’s Definition:

– Motivational interviewing is a collaborative conversation

style for strengthening a person’s own motivation and

commitment to change.

• Practitioner’s Definition:

– Motivational Interviewing is a person-centered counseling

style for addressing the common problem of ambivalence

about change.

32

What MI is NOT

• Just being nice

• Rogerian therapy

• A “technique”

• A panacea

• Comprehensive Theory of Change

• Transtheoretical Model (TTM)

• Decisional balance

• Assessment feedback NOT required

• A way of manipulating people

33

How to Learn MI: 8 Skills

1. Openness to underlying assumption and spirit of MI.

2. Proficiency in client centered interpersonal skills,

especially accurate empathy.

3. Recognize change talk and commitment language.

4. Minimize resistance in responding to sustain talk.

5. Skill in eliciting and responding to change-talk.

6. Formulate an effective change plan.

7. Enlist commitment to the plan.

8. Blending MI with other therapies.

(Explore and resolve ambivalence – ongoing)

34

Where people get stuck in MI

1. Underlying Assumptions

2. Reflective Listening

3. Recognizing Change Talk

4. Evoking Change Talk

5. Collecting Bouquets (Summarizing)

6. Responding to Resistance

7. Evoking and Strengthening Commitment

8. Transfer to Other Therapeutic Methods

35

A Motivational Interviewing Parable

A traveler in ancient Greece had lost his way

and, seeking to find it, asked a man by the roadside

who turned out to be Socrates. “How can I reach Mt.

Olympus?” asked the traveler. To this inquiry

Socrates is said to have gently replied “Just make

sure that every step you take goes in that direction.”

Source: Discover the Power Within You

By: Jeff Butterworth (Chapter 3)

36

Spirit of MI: Four Vital AspectsThe practice of MI Spirit is a developmental process

MI Spirit

PARTNERSHIP

COMPASSION

EVOCATION

ACCEPTANCE

1. Partnership

2. Acceptance

3. Compassion

4. Evocation37

The Spirit of Motivational Interviewing

Collaboration

Evocation

Autonomy

Confrontation

Education

Authority

VS.

MI is a mind and heart set.

38

Four Aspects of Acceptance

Acceptance

Absolute Worth

Autonomy

Accurate Empathy

Affirmation

39

Continuum of Communication Styles

Directing ↔ Guiding ↔ Following

↑ MI ↑

41

Verbs Associated with Each Communication StyleDirecting Style Guiding Style Following Style

Administer Accompany Allow

Authorize Arouse Attend

Command Assist Be Responsive

Conduct Awaken Be with

Decide Collaborate Comprehend

Determine Elicit Go along with

Govern Encourage Grasp

Lead Enlighten Have faith in

Manage Inspire Listen

Order Kindle Observe

Preside Look after Shadow

Rule Motivate Stay with

Steer Offer Stick to

Run Point Take in

Take charge Show Take interest in

Take Command Support Understand

Tell Take along Value42

The Processes of MI

1. Engaging: The relational foundation

2. Focusing: The strategic direction

3. Evoking: Preparing for change

4. Planning: The bridge to change

Pre-contemplation Preparation Action 43

MI Methods

1. Engaging

2. Focusing

3. Evoking

4. Planning

ENGAGING

FOCUSING

EVOKING

PLANNING

44

Questions Regarding Each MI Process

Engaging

• How comfortable is this person in talking to me?

• How supportive and helpful am I being?

• Do I understand this person’s perspective and

concerns?

• How comfortable do I feel in this conversation?

• Does this feel like a collaborative partnership?

45

Engagement Traps to Avoid

1. Assessment

2. Expert

3. Premature Focus

4. Labeling

5. Blaming

6. “Chat-Therapy”

46


Focusing

• What goals for change does this person really have?

• Do I have different aspirations for change for this

person?

• Are we working together with a common purpose?

• Does it feel like we are moving together, not in

different directions?

• Do I have a clear sense of where we are going?

• Does this feel more like dancing or wrestling?47


Evoking

• What are this person’s own reasons for change?

• Is the reluctance more about confidence or

importance of change?

• What change am I hearing?

• Am I steering too far or too fast in a particular

direction?

• Is the righting reflex pulling me to be the one

arguing for change?48


Planning

• What would be a reasonable next step toward change?

• What would help this person to move forward?

• Am I remembering to evoke rather than prescribe a

plan?

• Am I offering needed information or advice with

permission?

• Am I retaining a sense of quiet curiosity about what

will work best for this person?49

Phase I: Build Motivation to Change (Why)

1. Opening Strategies

A. Use OARS � Open-ended questions

Affirm

Reflect

Summarize

B. Agenda Setting

C. Scaling Questions

2. Decrease Resistance:

A. Reflections

1. Paraphrase

2. Amplified

3. Double-sided

B. Others

1. Shift-focus

2. Reframe

3. Agree w/twist

(Reflect/Reframe)

4. Emphasize Personal Control

5. Coming Along Side50

3. Evoke “Change-Talk”

A. Types:

1. Disadvantage of Status Quo

2. Advantage of change

3. Optimism for change

4. Intention to change

B. Methods:

1. Evocative questions

2. Elaborate

3. Importance/Confidence rulers

4. Explore decisional balance

5. Query extremes

6. Look behind/look forward

7. Explore goals (values)

C. Look for: DARN-CaT

Desire

Ability

Reasons

Need

----------------

Commitment

And

Taking Steps

4. Responding to Change-Talk (EARS)

1. Elaborate

2. Affirm

3. Reflect

4. Summarize

51

Phase II: Strengthening Commitment to Change (How)

1. Recapitulation (Grand Summary)

2. Ask Key Questions

· Where do we go from here?

· What do you want to happen?

· What’s the next step

· Where do you see yourself in 2-4 weeks?

· What might interfere with this?

· Who are your support people?

3. Provide information/Advise with permission

· May I offer some possibilities/options?

· Are you interested in some suggestions?

· Are you open to other considerations?

· Would a review of some options be helpful?

· Are you looking for helpful information?

52

4. Negotiate a Change Plan

· Go to Change Plan worksheet

5. End tasks:

· Summary Reflection

· Close the deal- “Is this what you want to do?”

6. Helpful Hints

· 2 Reflections/questions

· We can dance or wrestle

· Empathy=accurate reflection of client’s meaning

· Avoid questions or comments that elicit resistance

· Reduce resistance, evoke change-talk

· Stabilize the changes

53

“If a patient wants to go, let him go. If he wants to stay,

let him stay. Do not deny him what he wants and do not

suppress him. If we comply to his wishes and let him

satisfy his needs, then all of his excessive positive force

will be appropriately discharged and he will

consequently get well.”

- Zhang Zhongiing

Ca. 200 A.D.

54

Least Favorite/Most Favorite Person Exercise

Least Favorite Most Favorite

55

Motivational Interviewing Facilitates Change By:

• Reducing resistance

• Raising discrepancy

• Eliciting change-talk

• Responding to change-talk

•Creating a change plan

• Sustaining change

56

Conditions that Enhance ChangeRollnick and Miller (2002)

• is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. (p.25)

• elicits change from within, (not imposed). (p. 326)

• makes client responsible for change. (p. 326)

• avoids direct persuasion. (p.326)

• is interactive/directive. (p. 327)

• resolves ambivalence. (p. 327)

• works through the therapeutic “partnership”. (p. 327)

Motivational Interviewing:

57

Key Assumptions Behind Motivational

Interventions

• Encourage empathy

• Maintain congruence

• Promote collaborative spirit

• Recognize ambivalence is normal

• Resistance can be altered

• Support self-efficacy

58

Principle 1: Express Empathy.

• Acceptance facilitates change.

• Skillful reflective listening is

fundamental.

• Ambivalence is inevitable.

59

“Being empathic is to perceive the internal

frame of reference of another with accuracy

and with the emotional components and

meanings which pertain thereto...it means to

sense the hurt or pleasure of another as he

senses it and to perceive the causes thereof as

he perceives them...”

- Carl Rogers

61

Components of Empathy

1. Cognitive: Understand another’s situation,

perspective, feelings, and motives

2. Affective: Appreciation of emotional

reactions to perceived experiences

3. Behavioral: Capacity to communicate

understanding; verbal and nonverbal

expression

• Different from “detachment”

• Not the same as “sympathy”62

Empathy – “The not-so-secret sauce” that:

• Expedites therapeutic rapport

• Boosts client satisfaction

• _______ treatment efficiency

• Improves treatment outcomes

• Reduces practitioner stress

63

Strategies for Conveying Empathy

Non-verbal

• Voice tone

• Facial

expression

• Pausing

• Eye contact

• Posture

Stance

• Welcoming

• Respectful

• Authentic

• Accepting

• Patient

Verbal

• Inviting input

• Open-ended questions

• Reflective listening

• Non-interrupting

• Checking for accuracy

of understanding

• Asking for permission

64

Principle 2: Develop Discrepancy.

• Client presents argument for change.

• Discrepancy is the difference between present

behavior and future goals.

• Exaggerate discrepancy.

65

Discrepancy (2)

“Are your current behaviors leading toward or away from

your goals/values?”

Status Quo

“Sustain-Talk”

(No Change)

=

Goals

“Commitment-Language”

(Behavior Change)

=

Resistance Motivation

vs.

66

Principle 3: Roll with Resistance

• Avoid arguing for change.

• Avoid direct opposition.

• Invite new perspectives, do not impose.

• Client is responsible for finding solutions.

• Resistance is a signal to respond differently.

67

Principle 4: Support self-efficacy

• Self-efficacy = a client’s belief in their ability

to succeed.

• Reinforce self-efficacy frequently.

• Individual is responsible for change.

• Provider’s view of client’s self-efficacy affects

outcome.

68

Question-Answer Trap

Trap of Taking Sides

Expert Trap

Labeling Trap

Premature Focus Trap

Blaming Trap

Traps to Avoid

69

1. The speaker does not say exactly what is

meant.

2. The listener does not hear the words

correctly.

3. The listener gives a different interpretation

to what the words mean.

4. The speaker does not “feel” understood.

Communication can go wrong because…

70

Active Listening(Thomas Gordon, Ph. D.)

What is said

What is meant/felt

What is heard

What is understood

1

2

3

4

Client Facilitator

71

The Process of Communication

Words the

Speaker SaysWords the

Listener Hears

What the Listener

Thinks the Heard

Words Mean

What the Speaker

Means

Based on Gordon (1970)

Reflection

DecodingEncoding

Hearing

72

Thomas Gordon’s 12 Roadblocks to Listening

1. Ordering, directing, or commanding

2. Warning, cautioning, or threatening

3. Giving advice, making suggestions, or providing solutions

4. Persuading with logic, arguing, or lecturing

5. Telling people what they should do; moralizing

6. Disagreeing, judging, criticizing, or blaming

7. Agreeing, approving, or praising

8. Shaming, ridiculing, or blaming

9. Interpreting or analyzing

10. Reassuring, sympathizing, or consoling

11. Questioning or probing

12. Withdrawing, distracting, humoring, or changing the

subject

(From the Facilitator)

73

Which Roadblock Error?

CLIENT INTERVIEWER

“I just don’t now whether to leave him

or not.”

“You should do whatever you think is

best.”

“But that’s the point! I don’t now

what’s best!”

“Yes, you do, in your heart.”

“Well, I just feel trapped, stifled in our

relationship.”

“Have you thought about separating

for a while to see how you feel?”

“But I love him, and it would hurt him

so much if I left!”

“Yet, if you don’t do it, you could be

wasting your life.”

“But isn’t that kind of selfish?” “It’s just what you have to do to take

care of yourself.”

“I just don’t know how I could do it,

how I’d manage.”

“I’m sure you’ll be fine.”

#5

#6

#3

#2

#4

#1074

Categories of “resistance”

•Arguing

•Interrupting

•Negating

•Ignoring

Non-change Behavior

(From the Client)

75

Four Categories of Client Resistance Behavior

Arguing

• Challenging

• Discounting

• Hostility

76

Interrupting

• Talking over

• Cutting off

77

Negating

•Blaming

•Disagreeing

•Minimizing

•Pessimism

•Reluctance

78

Ignoring

•Inattention

•Nonanswer

•No response

•Sidetracking

79

Four Core Skills of MI (OARS)

(O): Open-ended Questions

(A): Affirming

(R): Reflective Listening

(S): Summarizing

80

1. Ask open-ended questions.

2. Directly affirm and support the client.

3. Listen reflectively.

4. Summarize periodically.

Using O.A.R.S.

81

CORE MI SKILLS (OARS)

Open-ended questions:

• What brings you here today?

• How has this problem affected your day-to-day life?

• Where do you hope your life might be different 5 years

from now?

• Where do you think this path that you’re on is leading

you?

• What would you say are the five things that you most

value in life?

• How do you hope I might be able to help you?82


Closed-ended questions:

• What is your address?

• How long have you been feeling this way?

• How many calls have you made?

• Do you smoke?

• Do you think you can do this?

• Who lives with you?

• When did you have your last drink?

• Where did that happen? 83

1. What do you like about your current situation? ___

2. Is this strategy effective? ___

3. What kind of specific assistance are you looking for? ___

4. Have you ever considered just going to AA? ___

5. Isn’t it important to you to follow your doctors orders? ___

6. What obstacles do you anticipate in making the specific changes

we’ve discussed? ___

7. What are the most important reasons for making these changes? ___

8. Don’t you care about your health? ___

9. What do you think about coming back for a follow-up visit? ___

10. Is this an open or closed question? ___

EXERCISE

Is it an open or closed question?

84

Open-Ended Questions

•Stimulates elaboration

•Asks for more than 1 word responses

•Examples:

•“What would you be doing differently if you

had already made the change you're

considering?”

•“How might you get from where you are today

to where you want to be in the near future?”

85

“Good listening helps a person keep going, to

continue considering and exploring what may

be uncomfortable material.”

- MI-3, p. 49

86


Affirming

• To Affirm is to:

– Accentuate the positive

– Recognize and acknowledge the good

– Supports

– Encourage

– Positive regard and respect

• What you say, think, and feel matters

87

AFFIRM = “you” statements (motivates)

VERSUS

PRAISE = “I” statements (roadblock)

88

Affirm/Support

•Use complements and statements of appreciation and

understanding

Examples:

“I think it’s great that you want to tackle this

problem.”

“I appreciate your willingness to discuss this.”

89


Examples of Affirmations:

• “You really tried hard this week!”

• “Your intention was good even though it didn’t turn

out as you would like.”

• “Look at this! You did a really good job of keeping

records this week.”

• “Thanks for coming in today, and even arriving early!”

• “So you made three calls about possible jobs this week.

Good for you!”90


Well Formed Reflections:

• Guess at meaning / hypothesis testing

• Decrease Defensiveness, Increase Exploration

• Moves the conversation forward

• Assumes client knows best

• Focuses on client narrative (not providers)

• Sees through client’s eyes

• Solidifies engagement

92

Reflective Listening

Techniques That Reduce Resistance

Simple Reflection

Amplified Reflection

Double-sided Reflection

93

Simple Reflection

Repeating or rephrasing what a client has said to you is

one way to let the person know that you heard them.

Client - But I can’t quit using. I mean, all of my

friends get high!

Facilitator – Quitting seems nearly impossible

because you spend so much time with others who

use.

Client – Right, although maybe I shouldn’t.

94

Amplified Reflection

With this, the facilitator will want to cause the client to disagree

with what’s being said. The facilitator may exaggerate or intensify the

point in order to accomplish this, however, it is important not to over-

embellish. If the client feels threatened he or she may respond in anger.

Client - But I can’t quit using. I mean, all of my friends

get high!

Facilitator – Oh, I see. So you already couldn’t quit

because then you’d be too different to fit in with your

friends and they might not accept the “new you”.

Client – Well, that would make me different from them,

although they might not really care as long as I don’t

pressure them to quit.95

Double-sided Reflection

The facilitator reflects both the current, resistant

statement with a previous, contradictory statement that the

client has made.

Client - But I can’t quit using. I mean, all of my

friends get high!

Facilitator – You can’t imagine how you could not

get high with your friends, and at the same time

you’re worried about how it’s affecting you.

Client – Yes. I guess I have mixed feelings.

96


Types of Reflections:

1. Simple = Paraphrase

2. Complex = Adds Meaning and Feelings

Simple Reflections

are what shows

above the water.

Complex Reflections

are what shows

beneath the water.

97

Asking Questions v. Making Statements

• You’re feeling uncomfortable?

• You’re feeling uncomfortable.

• You don’t think this is a problem?

• You don’t think this is a problem.

• You’re considering divorce?

• You’re considering divorce.

98

Summaries (1)Three types:

1. Collecting –

The bouquet: Putting it all together

2. Linking Phrases –

“On the one hand...on the other”

“At the same time”

Ex. – “On the one hand, you’re concerned that your drinking is affecting your health. On the other, you’re not sure if you want to stop.“

3. Transitional to the next phase –

“Let me see if I have everything so far...”

(at the end of one session)

“Let’s review briefly where we are...”

(at the beginning of the next session)

99

Summaries (2)

• Special form of reflection

• Selective – facilitator chooses what to emphasize

• Lets client know you’re listening

• Includes: Client’s concerns about change, problem

recognition, optimism, and ambivalence about change

• Invite client to respond: “Have I left out anything...?”

100


Summarizing

• Collecting – “a bouquet”

• Linking – Connecting past and present

• Transitional – Shifting from old to new.

101

“Listening Is An Act of Love”

Dave Isay (2007)

102

O.A.R.S. CodingListen for examples of the speaker’s use of each of the O.A.R.S. responses. As you hear

them, place a hash mark (/) in the appropriate row. Make notes of examples of each type

of O.A.R.S. response that you heard.

Facilitator Response Count (Hash Marks) Good example(s)

Open-Ended questions

Affirm

Reflect

Summary

103

Strategic Responses to Diffuse

Resistance

1. Shifting focus = Move attention away from barriers.

2. Reframing = A positive interpretation to negative info.

3. Agreement w/twist = Agree with client, then add change of direction.

4. Side w/the negative = Take the “no-change” side of ambivalence.

5. Personal choice = “It’s really up to you.”

6. Support self-efficacy = Emphasize hope, feasibility, optimism

7. Coming Along Side = Match client’s position.

104

Types of Change TalkSelf-Motivating Speech

• Disadvantages of Status Quo

• Advantages of Change

• Optimism for Change

• Intention to Change

105

Recognizing Change Talk

“DARN-CaT”

• What is Change Talk?

• How do we know when we hear it?

We listen for and strengthen natural language expressions of

change:

D=Desire to Change (the “want to”)

A=Ability to Change (confidence)

R=Reasons to Change (argument for)

N=Needs to Change (importance)

C=Commitment to change (“I’ll try” – “I’ll do”)

and

T=Taking Steps (“I’ve done...”) 106

Change Talk

• DARN predicts commitment talk

• Commitment talk predicts change

• Taking Steps = Change is happening

107

Desire

Ability

Reasons

Need

(DARN)

Flow of Change Talk

Commitment

And

Taking Steps

(CaT)

Change

+ = Change

108

The Six Kinds of Change Talk

“DARN-CaT”Change Talk (+) To Change (-) Not to Change

Desire

Ability

Reasons

Need

Commitment

Taking Steps

Motivates

Progress

Toward

Action

(change)

Independent

Predictors of

Change

109

Relative Strengths of Commitment

Language

(1)

Weakest

(2)

Weak

(3)

Moderate

(4)

Stronger

(5)

Strongest

I hope to

I will try

I think I will

I suppose I will

I imagine I will

I suspect I will

I will consider

I guess I will

I will see (about)

I favor

I believe

I accept

I aim

I aspire

I am inclined

I anticipate

I predict

I presume

I look forward to

I consent to

plan to

I resolve to

I expect to

I concede to

I declare my

intention to

I dedicate myself

I am devoted to

I pledge to

I agree to

I am prepared to

I intend to

I am ready to

I guarantee

I will

I promise

I vow

I shall

I give my word

I assure

I know I will

110

Change Questionnaire

1. I want to __________ 0 1 2 3 4 5 6 7 8 9 10

Definitely Not Probably Not Maybe Probably Definitely

2. I could __________ 0 1 2 3 4 5 6 7 8 9 10


3. There are good reasons for me to

__________

0 1 2 3 4 5 6 7 8 9 10


4. I have to __________ 0 1 2 3 4 5 6 7 8 9 10


5. I intend to __________ 0 1 2 3 4 5 6 7 8 9 10


6. I am trying to __________ 0 1 2 3 4 5 6 7 8 9 10


What is the change that you are considering? to ______________________

Now answer each of the following questions about this change that you are considering. Wherever there is a

blank _________, think of the change that you have written above, and then circle the one number that best

describes where you are right now. For example, if you had written “get a job” on the line above, then item 1

would be “I want to get a job” and you would indicate how much you want to get a job.

112

7. I hope to __________ 0 1 2 3 4 5 6 7 8 9 10


8. I can __________ 0 1 2 3 4 5 6 7 8 9 10


9. It is important for me to

__________

0 1 2 3 4 5 6 7 8 9 10


10. I need to __________ 0 1 2 3 4 5 6 7 8 9 10


11. I am going to __________ 0 1 2 3 4 5 6 7 8 9 10


12. I am doing things to __________ 0 1 2 3 4 5 6 7 8 9 10


William R. Miller, Theresa B. Moyers, and Paul Amrhein (2005)

Department of Psychology, University of New Mexico, Albequerque

113

1. Asking evocative questions

“What worries you about this?”

“What problems has this behavior created

for you?”

2. Elaborating – Ask for Clarification –

Ask for specific examples

•In what ways…?

•How much…?

•What else?

3. Using the importance ruler

4. Exploring the decisional balance

Methods for Evoking Change Talk

114

5. Querying extremes

“What’s the worst that could happen if you don’t make

a change?”

“What’s the best thing that could happen?”

6. Looking back – Compare past to present

(Ex.) “Do you remember when things were going well? What

changed?

7. Looking forward – Envision a changed future

What would be better about your future?

8. Exploring goals and values

•Compare current behavior with values.

•Enhance discrepancy.

•Use positive motivation toward goals.

115

Elaborating change talk

Affirming change talk

Reflecting change talk

Summarizing change talk

Responding to Change Talk (1)

EARS

116

E – Elaborating

“So you’re thinking about setting a quit date. Tell me a

little more about that.”

A – Affirming

“I think it’s great that you’ve picked out an AA meeting

to attend.”

R – Reflecting

“So you’ve scheduled a time to meet with a personal

trainer, and you’re eager to get going.”

S – Summarize

“Now let me see if I have all of this, you have begun...”

Responding to Change Talk (2)

(E.A.R.S.)

117

Readiness for Phase II Work

• Decreased resistance to change.

• Decreased discussion about the problem and a feeling

of waiting for the next step.

• A sense of resolution in which the client may seem

more relaxed and unburdened about the problem.

• Increased change talk.

• Increased questions about change.

• Greater envisioning a future that includes the changes.

• Experimenting with possible change actions between

sessions.

118

Two Phases of Motivation

Phase 2

Strengthening Commitment

Phase 1

Building Motivation

119

Phase II Activities: Strengthening Commitment to Change (How)

1. Recapitulation (Grand Summary)

2. Ask Key Questions

· Where do we go from here?

· What do you want to happen?

· What’s the next step

· Where do you see yourself in 2-4 weeks?

· What might interfere with this?

· Who are your support people?

3. Provide information/Advise with permission

· May I offer some possibilities/options?

· Are you interested in some suggestions?

· Are you open to other considerations?

· Would a review of some options be helpful?

· Are you looking for helpful information?

120

4. Negotiate a Change Plan

· Go to Change Plan worksheet

5. End tasks:

· Summary Reflection

· Close the deal- “Is this what you want to do?”

6. Helpful Hints

· 2 Reflections/questions

· We can dance or wrestle

· Empathy=accurate reflection of client’s meaning

· Avoid questions or comments that elicit resistance

· Reduce resistance, evoke change-talk

· Stabilize the changes

121

[10 min.]

[40 min.]

[10 min.]

STEP 1:

Establish Rapport

STEP 2:

Review any previously collected objective assessment material.

Collect additional information about use.

STEP 3:

Continue to use OARS

MI Sandwich

122

Summary: Motivational Interviewing

•Motivation resides in the interaction

•Motivation can be influenced

•Clients always respond with motivation toward or away from

change

•Resistance informs the therapeutic relationship

•Resistance can be reduced or increased

•A collaborative relationship facilitates change

•Clients are responsible for their progress

•Ambivalence is normal

•Resistance is a signal to respond differently

•The provider’s and the client’s expectations affect outcome

•Arguing for change creates resistance

•A primary goal of MI is to help the client explore and resolve

ambivalence

123

Change Tool Kit

1. Agenda Setting

2. Scaling Question

3. Stepping Stones to Better Health

4. Levels of Reflection Worksheet

5. OARS Coding

6. Six Kinds of DARN-CaT

7. Change Questionnaire

8. Rulers

9. Planning Change

10. A Decisional Balance

11. Decisional Balance Worksheet

12. Change Plan Worksheets

13. BECCI

14. Resources125

An Agenda-Setting Chart

126

Scaling Question10

9

8

7

6

5

4

3

2

1

0

Most

Pressing

Least

Pressing

127

Stepping Stones to Better Health

Starting

Place

DestinationPossible Obstacles:

1. _____________

2. _____________

3. _____________

4. _____________

5. _____________

Possible Solutions:

1. _____________

2. _____________

3. _____________

4. _____________

5. _____________

128

Levels of Reflection WorksheetListen for reflections the counselor makes. Write the level in the Reflection Level column. Write

what the counselor actually said in the Counselor’s Words column on the line next to the level of

reflection.

•Level 1 – Repeat using the same words.

•Level 2 – Rephrase using similar words.

•Level 3 – Paraphrase capturing meaning and emotions.

Perhaps adding something implied but not stated.

Reflection Level Counselor’s Words

129

O.A.R.S. CodingListen for examples of the speaker’s use of each of the O.A.R.S. responses. As you hear them,

place a has mark (/) in the appropriate row. Make notes of examples of each type of O.A.R.S.

response that you heard.

Facilitator Response Count (Hash Marks) Good example(s)

Open-Ended

questions

Affirm

Reflect

Summary

130

The Six Kinds of Change Talk

“DARN-CaT”Change Talk (+) To Change (-) Not to Change

Desire

Ability

Reasons

Need

Commitment

Taking Steps

Motivates

Progress

Toward

Action

(change)

Independent

Predictors of

Change

131


1. I want to __________ 0 1 2 3 4 5 6 7 8 9 10


2. I could __________ 0 1 2 3 4 5 6 7 8 9 10


3. There are good reasons for me to

__________

0 1 2 3 4 5 6 7 8 9 10


4. I have to __________ 0 1 2 3 4 5 6 7 8 9 10


5. I intend to __________ 0 1 2 3 4 5 6 7 8 9 10


6. I am trying to __________ 0 1 2 3 4 5 6 7 8 9 10


What is the change that you are considering? to ______________________

Now answer each of the following questions about this change that you are considering. Wherever there is a

blank _________, think of the change that you have written above, and then circle the one number that best

describes where you are right now. For example, if you had written “get a job” on the line above, then item 1

would be “I want to get a job” and you would indicate how much you want to get a job.

132

7. I hope to __________ 0 1 2 3 4 5 6 7 8 9 10


8. I can __________ 0 1 2 3 4 5 6 7 8 9 10


9. It is important for me to

__________

0 1 2 3 4 5 6 7 8 9 10


10. I need to __________ 0 1 2 3 4 5 6 7 8 9 10


11. I am going to __________ 0 1 2 3 4 5 6 7 8 9 10


12. I am doing things to __________ 0 1 2 3 4 5 6 7 8 9 10



Department of Psychology, University of New Mexico, Albequerque

133



Department of Psychology, University of New Mexico

Amrhein, P.C., Miller, W.R., Yahne, C.E., Palmer, M., & Fulcher, L. (2003). Client commitment language during motivational interviewing predicts

drug use outcomes. Journal of Consulting and Clinical Psychology, 71, 862-878.

The CQ was developed as a brief measure of six different components of motivation for change, based on

psycholinguistic analyses of natural language (Amrhein, et. al., 2003). In order to complete the questionnaire, the

respondent must have a particular change in mind. That change is specified at the top of the questionnaire, and the

open line (__________) in each item then represents that same change. It is also possible to modify the items of the

CQ to specify a particular change. For example, “quit drinking” could be substituted for the open line in every item.

Item 1 would then read, “I want to quit drinking.” (The instructions at the top of the questionnaire would also need to

be modified.) The key word in every item is intentionally emphasized by boldface italic font in order to focus

respondents on the aspect of motivation that is being queried.

Scoring Key:

There are six subscales, each of which consists of two items. Each subscale score is the sum of responses to the two

key items. The six subscale scores can also be summed to compute a total CQ score.

Desire Ability Reasons Need Commitment Taking Steps Total

Item 1: __ Item 2: __ Item 3: __ Item 4: __ Item 5: __ Item 6: __

Item 7: __ Item 8: __ Item 9: __ Item 10: __ Item 11: __ Item 12: __

Sum: ___ _____ _____ _____ _____ _____ _____

134

How important is it to you to change this?

0…..1…..2…..3.….4…..5.….6…..7.…..8…..9…..10

Not at all Extremely

How confident are you that you can change this?

Rulers

How much do you desire to change this?

0…..1…..2…..3.….4…..5.….6…..7.…..8…..9…..10

No confidence Completely confident

0…..1…..2…..3.….4…..5.….6…..7.…..8…..9…..10

Dread changing Excited about change

135

A

(Mo

tiv

atio

n)

(Confidence)

B

10

0

0 10

Adapted from Health Behavior Change: A Guide for Practitioners by Stephen Rollnick, Pip Mason, and Chris Butler (Churchill

Livingstone 1999) 186, with permission from Elsevier.

136

Resolving Ambivalence

The Decisional Balance

Costs of Status Quo

Benefits of Change

Costs of Change

Benefits of Status Quo

137

A Decisional Balance Sheet

Continue to drink as before Abstain from alcohol

Benefits Costs Benefits Costs

Helps me relax Could lose my family Less family conflict I enjoy getting high

Enjoy drinking with

friends

Bad example for my

children

More time with my

children

What to do about my

friends?

Damaging my health Feel better physically How to deal with

stress?

Spending too much

money

Helps with money

problems

Impairing my mental

ability

Might lose my job

Wasting my time/life

Resistance Motivation Resistance

138

Name:_____________________ Date:____________

PROS AND CONS

Continuing Behavior Stopping Behavior

PROS (Benefits) CONS (Costs) PROS (Benefits) CONS (Costs)

Resistance Motivation Resistance

Decisional Balance Worksheet

139

A Change Plan Worksheet

The changes I want to make (or continue making) are:

The reasons why I want to make these changes are:

The steps I plan to take in changing are:

The ways other people can help me are:

I will know that my plan is working if:

Some things that could interfere with my plan are:

-What could I do to remedy these?

What will I do if the plan isn’t working:

140

Change Plan Worksheet Outline


List specific areas or ways in which you want to change.

Include positive goals (beginning, increasing, improving behavior)


What are some likely consequences of action and inaction?

Which motivations for change seem most important to you?


How do you plan to achieve the goals?

Within the general plan, what are some specific first steps you might take?

When, where, and how will these steps be taken?


List specific ways that other people can help support you in your change attempt.

How will you go about eliciting others’ support?


What do you hope will happen as a result of the change?

What benefits can you expect from the change?


Anticipate situations or changes that could undermine the plan.

What could go wrong?

How might you stick with the plan despite the changes or setbacks?


List the changes you would make when recycling back to contemplation stage.

Who would you enlist to help you with these changes?141

A Change Plan Worksheet Example


1. Stop smoking crack.

2. Reduce my drinking.

3. Take better care of my kids.


1. Get out of trouble with probation – avoid dirty urines.

2. Take better care of my health.

3. Give my kids a better chance.


1. Keep coming to group and treatment here.

2. Give urines to my P.O. every week.

3. Spend time each day focusing on my children

4. Go to my kids’ schools to meet their teachers.

5. Stop using crack, one day at a time.

6. Get a sponsor at NA.

7. Avoid hanging out with people who use.

8. Go back to church.

142


1. My P.O. can encourage me when I give a clean urine.

2. My counselor can help me deal with my depression.

3. My group can help me talk about my difficulties in quitting.

4. My mom can care for my kids when I’m working or at treatment.

5. My sponsor can help me when I have a craving.


1. I am not using crack.

2. I am giving clean urines.

3. I am coming to group 8 out of 10 times.

4. I am spending time each day focusing on my children and their needs.

5. I am going to NA 3 times a week.


1. If I get sent back to jail for a dirty urine.

2. If I don’t plan ahead for cravings and urges.

3. If I don’t stop hanging with using friends.

4. If I quit treatment.


1. Be honest with my counselor and my group and ask for help.

2. Make another plan that takes care of cravings/urges better.

3. Tell my P.O. I need residential treatment or more treatment.

4. Refuse to let myself feel like a failure.143

Behavior Change Counseling Index (BECCI)BECCI is an instrument designed for trainers to score practitioners’ use of Behavior Change Counseling in consultations (either real or

simulated). To use BECCI, circle a number on the scale attached to each item to indicate the degree to which the patient/practitioner has

carried out the action described.

Before using BECCI, please consult the accompanying manual for a detailed explanation of how to score the items. As a guide while

using the instrument, each number on the scale indicates that the action was carried out:

0=Not at all; 1=Minimally; 2=To some extent; 3=A good deal; 4=A great extent

The Topic: ________________________________________________________

Item Score

1. Practitioner invites the patient to talk about behavior change. Not applicable □ Not at all A Great Extent

0 1 2 3 4

2. Practitioner demonstrates sensitivity to talking about other issues. 0 1 2 3 4

3. Practitioner encourages patient to talk about current behavior or status quo. 0 1 2 3 4

4. Practitioner encourages patient to talk about change. 0 1 2 3 4

5. Practitioner asks questions to elicit how patient thinks and feels about the topic. 0 1 2 3 4

6. Practitioner uses empathic listening statements when the patient talks about the

topic.

0 1 2 3 4

7. Practitioner uses summaries to bring together what the patient says about the topic. 0 1 2 3 4

8. Practitioner acknowledges challenges about behavior change that the patient faces. 0 1 2 3 4

9. When practitioner provides information, it is sensitive to patient concerns and

understanding. Not applicable □

0 1 2 3 4

10. Practitioner actively conveys respect for patient choice about behavior change. 0 1 2 3 4

11. Practitioner and patient exchange ideas about how the patient could change current

behavior. Not applicable □

0 1 2 3 4

Practitioner BECCI Score: ____________________

Practitioner speaks for approximately: More than half the time □ About half the time □ Less than half the time □

(University of Wales College of Medicine, 2002)

144

Blending SOC and MI

Tomlin and Richardson

(2004)

145

Matching Motivational Tasks to the Stages of Change

Client Stage of Change Facilitator’s Motivational Tasks

Precontemplation Raise doubt – increase the client’s perception of risks

and problems with current behavior

Contemplation Tip the balance – evoke reasons to change, risks of not

changing, strengthen the client’s self-efficacy for change

of current behavior

Preparation Provide the client with a menu of options to determine

the best course of action to take in seeking change

Action Assist the client in implementing the plans toward

change

Maintenance Facilitate a process to identify and use strategies to

prevent relapse

Relapse Help the client to recycle back to the processes of

contemplation, determination, and action, without

becoming stuck or demoralized because of relapse

146

Appropriate Motivational Strategies for Each Stage of Change

Stage Goals Interventions

Pre-

contemplation

Help client engage in

change process and

begin considering

patterns and potential

effects of the behavior

in question

•Establish rapport, build trust.

•Explore and “decontaminate” the referral process.

•Affirm clients for willingness to attend and talk.

•Explore the meaning of events that brought the client to treatment.

•Elicit the client’s perceptions of their behaviors and the larger situation.

•Offer factual information about the behavioral problem.

•Provide personalized feedback about assessment findings.

•Explore the good things and less good things about the behavior problem

•Express concern and “keep the door open.”

Contemplation Help client see the “big

picture”, discover

discrepancies between

current behavior and

future goals, and

consider making some

lifestyle changes.

•Normalize ambivalence.

•Help the client tip the decisional balance scales toward change by:

–Eliciting and weighing pros and cons of continuing behavior

versus changing

–Examining the client’s personal values in relation to change

–Imagining the future

–Emphasizing the client’s free choice, responsibility, and self-

efficacy for change

•Elicit self-motivational statements of intent and commitment from the

client.

•Elicit ideas regarding the client’s expectations regarding treatment.

•Summarize change talk.

•Assess client’s sense of importance and confidence in changing.

(From Prochaska, DiClemente, & Norcross (1992), adapted by Chris Wagner)

147

Stage Goals Interventions

Preparation Help client resolve

ambivalence about

changing, develop a

sense of ability to

change, and make

initial plans for going

about changing.

•Clarify the client’s own goals and strategies for change.

•Develop a menu of options for change.

•With permission, offer expertise and advice.

•Help the client develop a change plan.

•Help the client enlist social support.

•Assist the client in decreasing barriers to change (e.g. financial, child

care).

•Ask client to consider announcing plan to change (“going public”)

•Help client to identify and plan for high-risk situations and other negative

aspects of change.

Action Help client initiate

change, cope with

difficulties in the

change process, and

gain social support for

new ways of being.

•Support small steps toward change.

•Acknowledge difficulties and losses involved in change.

•Assist the client in finding new reinforcers of positive change

•Help client access and use social support.

•Identify current triggers of behavior

•Help client cope with unanticipated negative “side-effects” of changing

•Reframe setbacks and lapses as signs the plan needs re-tuning and

ultimately will help improve the long-term plan.

•Generate additional change strategies.

Maintenance Help client cope with

difficult situations,

maintain commitment

and energy, initiate new

facets of living to protect

against behavior relapse,

and process through

relapses that occur.

•Affirm client’s resolve and self-efficacy

•Maintain contact and reaffirm appropriateness of seeking support.

•Assist client in making the transition to working on other long-term

goals.

•Express willingness to assist client in event of setback or relapse.

148

ResourcesI. Stages of Change

1. Prochaska, J.O., Norcross, J.C., and DiClemente, C.C. (1994). Changing For Good: A Revolutionary Six-

Stag Program for Overcoming Bad Habits and Moving Your Life Positively Forward. New York: Avon Books,

INC.

2. Prochaska, J.O., Norcross, J.C. (1994). Systems of Psychotherapy: A Transtheoretical Analysis, 3rd ed. Pacific

Grove, CA.: Brooks/Cole

3. DiClemente, C.C. and Hughes, S.O., (1990). “Stages of Change Profiles in Alcoholism Treatment.” Journal of

Substance Abuse, 2, 217-235.

II. Motivational Interviewing

1. Arkowitz, H., et.al., (2008). Motivational Interviewing for the Treatment of Psychological Problems. New

York, The Guilford Press

2. Enhancing Motivation for Change: Inservice Training – Based on a Treatment Improvement Protocol (TIP35).

(2006) U.S. Department of Health and Human Services, (SAMHSA) Pub. # (SMA)06-4190, Rockville, MD.

3. Miller, W.R. and Rollnick, S. (2013). Motivational Interviewing: Programming People for Change, 3rd ed.

New York: The Guilford Press.

4. Miller, W.R., Zweben, A., DiClemente, C.C., &Rychtarik, R. (1992). Motivational enhancement therapy

manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence

(Project MATCH Monograph Series, Vol. 2.) Rockville, MD: National Institute on Alcohol Abuse and

Alcoholism.

5. Substance Abuse and Mental Health Services Administrators, Center for Substance Abuse Treatment, U.S.

Department of Health and Human Services. (2003). Enhancing Motivation for Change in Substance Abuse

Treatment (TIP 35 – Publication # (SMA) 03-3811). Rockville, MD: Miller.

6. Rollnick, S.; Mason, P.; and Butler, C.; (1999) Health Behavior Change: A Guide for Practitioners.

Edinburgh: Churchill Livingstone.

7. Rollnick, S., Miller, W., and Butler, C., (2008). Motivational Interviewing in Health Care: Helping Patients

Change Behavior. New York, The Guilford Press.

8. Walters, S., et. al, (2007) A Guide for Probation and Parole: Motivating Offenders to Change. Washintgon,

D.C.: National Institute of Corrections

149

III. Stages of Change and Motivational Interviewing

1. Tomlin, K., and Richardson, H. (2004). Motivational Interviewing and Stages of Change: Integrating Best

Practices for Substance Abuse Professionals. Center City, Miinn: Hazelden.

IV. Additional Resources

Video Training Series:

Motivational Interviewing Professional Videotape Series 1998 - A six tape set at $120.00 – from:

University of New Mexico, Center on Alcoholism, Substance Abuse, and Addiction (CASAA)

2350 Alamo, S.E., Albuquerque, NM 87106

Websites:

1. www.motivationalinterview.org

2. www.CASAA.unm.edu

3. Addiction Technology Transfer Center – www.Nattc.org

4. Substance Abuse and Mental Health Services Administration – www.samhsa.gov

*Resources on motivational interviewing, including general information, links, discussion board, training

resources, and information on reprints and the latest research.

Resources (2)

150

Evaluation FormMOTIVATIONAL INTERVIEWING

William B. Webb, Ph.D.

(For scoring purposes: Strongly Agree=4, Agree=3, Neutral=2, Disagree=1, Strongly Disagree=0)

PLEASE INDICATE YOUR AGREEMENT WITH

THESE STATEMENTS ABOUT THE TRAINING.

Strongly

Agree

Agree Neutral Disagree Strongly

Disagree

1. The training was well-organized.

2. The material presented is applicable to my clinical

work.

3. The trainer was receptive to participant comments

and questions.

4. The training enhanced my skills in this topic area.

5. I expect to use the information gained from this

training to benefit my clients.

6. The trainer effectively modeled motivational

interviewing behaviors.

7. Overall, how satisfied are you with your training

experience?

Very

Satisfied

□

Satisfied

□

Neutral

□

Unsatisfied

□

Very

Unsatisfied

□

8. What specific forms or skills are the most helpful in supporting you as a service provider?

9. What about the training will be difficult to apply in your daily work as a service provider?

10. How can the Trainer improve this training?

Thank you for completing this survey.

Return your survey to the Trainer.

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wpls jan 2016 mi presentation...initial training a workshop is only the beginning of learning...

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